Dr. Keith Lorio is a General Dentist whose practice focuses on TemperoMandibularJoint (TMJ) and Craniomandibular Disorders and Dysfunction.

What is TMJ/TMD?
TMJ stands for Temperomandibular Joint.  This is your jaw joint.  TMD means Temperomandibular Joint Disorder.

WHO DO WE WANT TO HELP?

Individuals who experience unresolved jaw pains, muscle tension that effects the head and neck region as well as temporomandibular joint derangement problems. We strive to help patients who may not have seen anyone to be treated.  However, we especially seek to help those who have seen a variety of dental and medical professionals and have limited to no resolution of their symptoms. 

Maybe you have tried multiple types of splint, guards, and other appliances.  Your teeth may have been adjusted, grinded on or equilibrated, and still you are having problems.  Maybe you had previous orthodontics and now you are experiencing pain.  Maybe you have tried the neuromuscular dentistry approach that did not work for you.  You could have tried Botox multiple times.  Maybe you had several teeth restored with fillings and/or crowns and you cannot find your bite.  Maybe there are symptoms ranging from jaw soreness, headaches, clicking and popping, or ear issues.  Maybe you were in an accident and have tmj symptoms.  Sometimes you cannot find your bite.  Maybe your jaw clicks and locks.  You may have been told you need tmj surgery.  Maybe you had no dentistry, but still are having discomfort in your head, jaw, or neck.   Maybe you have been told this is all in your head and it is not real.  If this is you, you are who Dr. Lorio really wants to try helping. 

We hope to help patients with a multitude of musculoskeletal (muscle and bone) symptoms including:

• Headaches (tension type)

• Pain in the temples

• Pain in the occipital region (back of the head)

• Jaw Joint Pain

• Neck, Cervical Pain

• Postural issues (forward head position) (backward head position while chewing)

• Ear stuffiness

• Ear pain

• Dizziness (vertigo)

• Jaw clicking

• Jaw popping

• Jaw locking open or closed

• Cracking sound in jaw (crepitus)

• Limited jaw opening

• Clenching and/or grinding teeth

• Bite feels “off” or “changing”

• Multiple bites

• Sensitive teeth

• Worn down teeth

• Teeth that are chipping and breaking

• Pain behind the eye (sharp, dagger like pain)

• Discomfort in head:  Occipital (back), Temporal (side), and Frontal (front)

• Jaw soreness

• Jaw deviates to one side when opening and closing

• Face pain

• Insomnia (difficulty sleeping)

Learn about Dr. Lorio

Having practiced for 29 years, Dr. Lorio has a special place in his heart to help patients who have the symptoms listed above.  This has motivated him to further his post graduate training in the field of TMJ and muscle dysfunction, musculoskeletal disorders and craniomandibular dysfunction disorders.  Dr. Lorio uses advanced techniques that focus on re-establishing physiologic stability by first identifying the postural instabilities of the masticatory system using objective analysis that measures physiologic responses when the jaw rests, opens and closes.  Measuring how the teeth contact one another and positional measurements are assessed as to whether the teeth, muscles and temporomandibular jaw joints are harmonizing with one another to physiologic parameters. Correcting unstable conditions is a special area of dentistry that Dr. Lorio has unique skills, understanding and experience – treating those difficult cases that other professionals have not been able to resolve successfully. He has extensive training in the use of electro-diagnostic instrumentation and measuring technology to objectively diagnose and treat his patients effectively. He has received training under international leaders in these fields including Dr.’s Jeff Okeson, Peter Dawson, Frank Spear, Henry Gremillion, Michael Miyasaki, and Clayton Chan.  He has completed all of this post-graduate training for one mission.  That mission is to help patients who have been affected by these disorders. 

Dr. Lorio has received specialized and advanced occlusal and TMD training at Occlusion Connections (The Center for Gneuromuscular Dentistry and Advanced Orthopedics)  He has completed the TMD and Restorative continuum of training at Occlusion Connections.  This unique educational training and experience has led Dr. Lorio to integrate detailed management of his patient’s occlusion (bite), micro-occlusion principles and protocols combining both the gnathic and neuromuscular (GNM) approach to his treatment. 

What should I do first?

Patients should be checked first by their medical doctors for any underlying cause of symptoms.  This includes but not limited to neurologists, ENT’s, primary care physicians, chiropractors, etc. Underlying medical issues should be ruled out including but not limited to arteritis, tumors, vertebral disk problems, spine problems, Trigeminal Neuralgia, Fibromyalgia, etc.  However, if there is no resolution and neurological as well as other underlying issues have been ruled out, we may be able to help.  The problem could be the result of your bite.

Our Treatment Model

We use the bio-physiologic model.  We strive to reduce the symptoms through an emphasis on the bite, the muscles, and the jaw joints.  We use instrumentation, technology, and patient biofeedback to objectively determine a physiologic jaw relationship, the relationship of the upper and lower jaws. By obtaining this relationship, we often see our desired results.  We use an orthotic, a gnathologic appliance. An orthotic is worn and we strive to simulate an ideal bite with the optimal jaw relationship. This appliance is designed to incorporate gnathologic, neuromuscular, and physiologic instrumentation/technology as well.  With the technology, we objectively measure the jaw motion, muscle response, and jaw relationship.

We can use any or all of these modalities:

Digital imaging

Technological Advanced Equipment to:

Assess the health of the chewing muscles

Listen to the sound of the joints

Track and measure the proper relationship of the upper and lower jaw

Assess the proper relationship of the lower jaw to the upper jaw to restore a more optimal bite

Imaging to see the jaw

HEADACHES

Many of you reading this have probably experienced a headache at some point in your lifetime. An occasional headache is not usually something that requires the help of a medical professional. Most people take an over the counter pain reliever and go on with their lives. However, there are millions of people who live with frequent or chronic pain in their head and neck. Some of these people can have so much pain at times that it alters their normal daily activity and state of mind. The pain can get so intense that it causes them to seek medical attention. Some are diagnosed with migraine headaches. Migraines have become an overused and often misused term in the past few years. A true, classic migraine is thought to be a nerve/vascular event that occurs in the brain causing symptoms including intense headache, usually on one side of the head with nausea and sensitivity to light. The diagnosis is made from the patient’s report of symptoms only, no scan, image or blood test can show it.

More commonly, patients suffer from tension headaches. Tension headaches are simply (as the name implies) muscles that are tense and in spasm, causing pain. Muscles can tense and spasm with overuse, improper posture, skeletal misalignments and improper function of the movable parts of the body. When a muscle in any part of the body is in spasm, there is decreased blood flow and oxygen to the muscle which results in a buildup of a chemical called lactic acid. Lactic acid causes an intense pain response until the muscle relaxes and blood flow is restored. When this happens in the head and neck region, the pain is intensified, compared to other parts of the body, due to the proportionately larger number of nerves per square inch in the head and neck. In some patients, the pain of muscle tension can be so intense, that it causes nausea, pain in and around the eye, making them take pain medications and sit in a dark room. These symptoms mimic the classic migraine which is a less frequent type of headache. The National Institute of Health estimates that over 30 million people suffer from migraines, and the diagnosis is made purely from report of symptoms from the patient and CAT scans or MRI’s ruling out a tumor or brain abnormality. So, if tension headaches can cause the same intense symptoms, how does one know which type they are having?

Until recently, there was no way to distinguish between them. Treatment was with trial and error trying various types of prescription drugs like pain relievers, anti-depressants, muscle relaxers and even blood pressure medications. These medications in different combinations offer some patients varying levels of relief; however, they treat the symptoms not the source.

Statistically, a large majority of head and neck pain is muscular in origin. There is always a cause for muscle tension, it’s not a normal state, and pain is an indicator that something is wrong. The lower jaw is supported by a host of muscles in the head and neck that work together to allow normal function. If the bite is out of alignment (malocclusion), this can cause some or all of those muscles to become tense and spasm, as they try to accommodate to the bite position. It often results in headache, neck and shoulder pain, ear pain, pressure or ringing, dizziness or pain behind the eyes. Even if someone has had orthodontics (braces) to esthetically align the teeth, the muscles may not be comfortable in that position, resulting in these symptoms of varying degrees.

There is exciting new computerized technology available in a growing number of dental offices around the world, that allows the dentist to objectively identify and measure the location and amount of muscle activity in the head and neck, which can help distinguish between muscular and migraine headaches. With the aid of EMG’s (same technology as EKG), joint sonography, and computerized jaw tracking, the dentist can objectively tell if the jaw is improperly aligned, and if the muscles are in spasm. After the muscle activity is measured, then an ULF-TENS (Ultra Low Frequency-Transcutaneous Electronic Nerve Stimulation) is used, which is a way to give gentle rhythmic pulsing that increases blood flow and pumps out waste metabolites like lactic acid. The computerized jaw tracking is then used to find a better jaw position for the patient that the dentist can make a customized temporary orthotic that is worn on the lower teeth in order to stabilize the bite in that optimal position.

We have this advanced technology in our office and have been treating patients successfully for the past few years. The results can be dramatic and life changing for many patients. Many of the patients treated have been to multiple physicians, and had multiple tests performed, trying desperately to find the solution to their symptoms. We work with other health professionals like physical therapists, chiropractors, orthodontists, and physicians, in order to treat the supporting areas of the head and neck to relieve muscle pain in those areas as well. The goal is to treat the source or cause of the pain.

GRINDING TEETH WHILE SLEEPING (Nocturnal Bruxism)

During the day time, we can generate a certain maximum amount of force.  While sleeping, we can generate more than 4 TIMES the force.  This puts an extraordinary amount of load on our teeth, jaws, muscles, and joints.  We can see the results such as sensitive teeth, cracked teeth, tori (extra bone deposits), sore jaws, headaches, clicking and popping.

TMD Treatment:

Orthotic Therapy – Phase I (Stabilization diagnostic period 6-12 months or more)

TMD, Restorative, Orthodontic/Orthopedic – Phase II (once patient is 3 months pain free and off all medications for TMJ)

We work with other healthcare providers sometimes to help.

The human body is very complex and if required, Dr. Lorio collaborates with dentists, orthodontists, physicians, chiropractors, physical therapists, or other healthcare providers in order to help the patient.

Other treatments (See our section titled “What Causes TMD?”)

Botox

The use of Botox is more common now in attempt to treat TMD.  However, one may ask, is this really treating the cause of TMD or merely masking the symptoms?  Why do some inject a neurotoxin in the muscles many times if a more non-invasive treatment can work?

TMJ Surgery

This is an option but is usually used only as a last resort and we have not referred our patients for TMJ surgery.

Do you do fillings, crowns, other restorations, and orthodontics?
Sometimes restorations must be done in order to have enough tooth support for the orthotic to function properly.  More often, we only do fillings, crowns, and other restorations only if needed once the treatment goals are achieved with the orthotic appliance, and the patient desires to move forward with treatment.  We do not perform orthodontics, but work with orthodontists who we can show the desired jaw position to help with their treatment. 

Does this treatment work all the time?
No.  As with other dental treatments, we cannot guarantee treatment success.  However, we have helped many patients who have felt helpless from symptoms of TMD to be able to function back to normal.

Insurance

Dental insurance does not usually cover TMD treatment, but sometimes, medical insurance will cover some of the costs associated with Phase I treatment. In Louisiana there is a law concerning health insurance coverage of TMD treatment which is favorable for our state.  It merely depends on your particular health insurance policy. We will give you the necessary forms and insurance codes to help you with reimbursement.

Our treatment is very effective, but nothing is 100%

As with other dental treatments, we cannot guarantee treatment success.  However, we have helped many patients who have felt helpless from symptoms of TMD to be able to function back to normal.  Many of the patients we helped had seen multiple doctors for resolution and were unsuccessful.

Where can I learn more?
Contact our office at 225-769-4848.  We will meet with you for a consultation to discuss your case.

Fill out the TMJ Questionnaire to get started today!

TMJ QUESTIONNAIRE
Cranio-Mandibular Visual Assessment
Frequently Asked Questions